Ovarian cancer: the clinical role of US, CT, and MRI

Abstract

This article presents an overview of ovarian cancer, which addresses the clinical roles of imaging studies, including US, CT, and MR imaging in the course of diagnosis and treatment of this important disease. US is the modality of choice in the evaluation of patients with suspected adnexal masses. Although its accuracy is not sufficient to avert surgery, morphological analysis of adnexal masses with US helps narrow the differential diagnosis, determining the degree of suspicion for malignancy, usually in concert with a serum CA-125 level. Combined morphological and vascular imaging obtained by US appear to further improve the preoperative assessment of adnexal masses. For uncertain or problematic cases, MR imaging helps to distinguish benign from malignant, with an overall accuracy for the diagnosis of malignancy of 93%. The accuracy of MR imaging in the confident diagnosis of mature cystic teratoma, endometrial cysts, and leiomayomas is very high. CT is not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination, except for fatty tissue and for calcification, and the disadvantages of irradiation. In the staging of ovarian cancer, CT, US, and MR imaging all have a similarly high accuracy. Although it is difficult to suggest a simple algorithm for evaluating the state of women with adnexal masses, the correct preoperative diagnosis and staging of ovarian cancer with the use of any of these imaging studies will lead to an appropriate referral to a specialist in gynecologic oncology and offer a significant survival advantage for patients with ovarian cancer.

Bilateral Tubo-Ovarian Abscess Mimics Ovarian Cancer on MRI and 18F-FDG PET/CT

“…Fluid-filled tubular lesions with enhancing, thick walls are findings of pyosalpinx and are frequently seen adjacent to or in a portion of TOAs [14][15][16]. CT is generally not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination (except for fatty tissue and calcification) and the disadvantages of irradiation [17].…”

Clinical management of borderline tumours of the ovary: results of a multicentre survey of 323 clinics in Germany

“…On the basis of the current literature, vaginal ultrasound and possibly additional Doppler ultrasound as well represent the best diagnostic tool for the detection of BOT (Reles et al, 1997;Cohen and Fishman, 2002;Togashi, 2003;Schem et al, 2007). Results of our survey indicate the need for more adequate staging of borderline tumours in some hospital categories.…”

Visualization of Ovarian Tumors using 3T MR Imaging: Diagnostic Effectiveness and Difficulties

“…Though transabdominal or transvaginal ultrasound is thê rst choice for evaluating suspected adnexal masses, MR imaging is a cost-eŠective next step when ultrasonographicˆndings are indeterminate. [12][13][14] MR imaging is now recommended as well as a problem-solving modality for assessing complex adnexal masses. [10][11][12] Several reports have considered the value of MR imaging at 3T for examining the female pelvis.…”

“…9,10 We also evaluated 2 benignˆndings-a regular and homogeneous solid component with low signal intensity on T 2 WI or a fat component on T 1 WI with fat suppression. 11,12 A solid component Overall image quality: 1, poor, to 5, excellent; accuracy of diagnosis: 1, undiagnosable, to 5, diagnosable with high certainty. SD, standard deviation.…”